Degenerative Disc Disease Flashcards
Explain degenerative disc disease
Natural deterioriation of the intervertebral disc structure.
It becomes progressively weaker and start to collapse.
Patients may remain asymptomatic or can be in a lot of pain.
What is degenerative disc disease related to?
Aging causing:
Progressive dehydration of nucleus pulposus
Daily activities lead to tears of annulus fibrosis
Injuries and pathlogy lead to instability
Pathophysiology
Three stages:
Dysfunction -> outer annular tears and separation of endplate, cartilage destruction and facet synovial reaction.
Instability -> Disc resorption and loss of disc space height
Facet capsular laxity causing subluxation and spondylolisthesis.
Restabilisation -> Osteophyte formation and canal stenosis
Early Clinical features
Localised symptoms of local spinal tenderness, contracted paraspinal muscles and hypomobility.
Painful extension of back and neck
Examination is often unremarkable.
Late clinical features
Pain becomes more severe and cause radicular leg pain or paraesthesia
+ve Lasegue sign
Worsening muscle tenderness, stiffness, reduced movement and scoliosis
What is Lasegue test?
Straight leg raise to assess for disc herniation in patients presenting with lumbago (pain in lower back).
Patient is lying down and examiner lifts the patient’s leg while knee is straight.
You can also dorsiflex the ankle +/- flex cervical spine for further assessment.
+ve = Pain is elicited during leg raising +/- ankle dorsiflexion or cervical spine flexion.
Dx
CES
Infection
Malignancy
Red flag assessment
Faecal incontinence
Urinary retention and overflow incontinence
Saddle anaesthesia
Bilateral sciatica
Immunosuppression
Chronic steroid use
Osteoporosis
IVDU
Unexplained fever
Significant trauma
Metabolic bone disease
New onset after 50 yo or hx of malignancy
When should imaging be done?
Red flags
Radiculopathy with pain for more than 6 weeks
Suspicion of spinal cord compression
If imaging would significantly alter management
When is spine x-ray done?
Hx of recent significant trauma
Known osteoporotic
Aged over 70
Gold standard investigation
MRI (majority do not require imaging however)
MRI findings
Signs of degeneration
Reduction of disc heigh
Annular tears
Endplate changes
Mainstay management
Pain relief going simple analgesics -> neuropathic pain medication
Encourage mobility + physiotherapy
Only emergency intervention if CES with laminectomy or discectomy
When should you refer?
Pain continues beyond 3 months despite analgesia.
This should be referred to pain clinic.
Indications of surgical intervention.
Spinal fusion has previous been suggested but no evidence to support surgical intervention
Surgery might make back pain worse in long term.
